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Traumatic Clamshell Thoracotomy Closure Using Plates and Screws - a New Look for a Challenging Exposure: A Pilot Study
No full textBACKGROUND: The clamshell thoracotomy (CST) is a rare, but lifesaving procedure often performed in austere environments. The closure of a CST is challenging and can be fraught with post-operative complications/failure resulting in debilitating chest wall instability. The recent advent of rib and sternal fixation hardware has provided additional tools possibly offering better ways to close a CST. The objective of this study was to examine the use of plates and screws to close CSTs, hypothesizing it is safe and effective, providing good functional outcomes. METHODS: This was a multi-institutional, international, retrospective review of patients undergoing CST closure with plates and screws utilized in rib/sternal fixation. Exclusion criteria included patients that died prior to hospital discharge. Exact methods for closure were left to the discretion of the operating surgeon, however plates and screws were the main foundation. Basic demographics were obtained. Outcomes of interest included number of plates used, days to closure, complications post-operatively, length of follow-up, and post-operative functional status (1=worst functional status; 5=best functional status). Descriptive statistics were reported. RESULTS: Nineteen patients from 7 centers were included. Two patients were excluded as they died inpatient. Of the remaining 17 patients, mean age was 34.6 (±18.8) years and 82.4 % were male. 35.3 % percent were white, 41.2 % were black, and 23.5 % were Hispanic. 82.4 % suffered penetrating trauma. Median number of plates used per patient was 1 (Interquartile range (IQR) 1,3). Median time to closure was 1 day (IQR 1,2). Four patients (23.5 %) experienced post-operative complications. Mean follow-up was 197.4 (±206.4) days with all patients obtaining satisfactory chest x-rays during this time. Median functional status reported by patients at follow-up was 4 (IQR 3,5). CONCLUSION: Clamshell thoracotomy closure with plates and screws appears to be safe and effective. Most patients reported favorable long-term functional status. LEVEL OF EVIDENCE: Level V, Therapeutic/care management
Performers With History of Voice Injury: A Survey Study of Treatment Outcomes and Vocal Function
No full textINTRODUCTION: Past studies show that performers are more susceptible to voice injury, have higher incidence of injury, and experience greater vocal impairment than non-performers. Despite literature demonstrating otherwise, there remains fear and stigma that voice injury is a career-ending circumstance. Much of this is due to a lack of information about post-treatment vocal function. METHODS: An anonymous online survey was distributed via email, flyer, and social media to a target audience of performers with a history of voice injury. It inquired about occupation, vocal symptoms, professionals consulted, and treatment adherence. Outcome measures included ability to perform, resolution of symptoms, and attitudes about their voices after voice injury. Findings were analyzed descriptively with statistical analysis to determine factors that may be related to favorable outcomes. RESULTS: The survey was completed by 151 performers representing a range of genres, including musical theatre, classical, and popular genres. The most reported vocal symptoms were decreased range, singing voice quality changes, increased singing effort, and vocal fatigue. Most initially sought care from an otolaryngologist, laryngologist, or voice teacher. Diagnoses and recommendations varied, but those who adhered to treatment were more likely to report resolution of voice symptoms (P = 0.025). Those with symptoms for 2-4 weeks reported greater vocal confidence than those with a longer symptom duration (P = 0.0251). Performers working with a voice teacher were more likely to find treatment helpful (P = 0.0174). Those with neurogenic voice conditions reported less vocal reliability than participants with other pathologies (P = 0.0155). CONCLUSION: The majority of participants continued to perform, reported resolved or improved voice symptoms after treatment, and reported positive attitudes about their voices, regardless of their injury or current presence or absence of pathology on exam. Findings of this study highlight a need for continued outreach to voice teachers, education programs, and production teams about vocal function after voice injury
Long-Term Administration of EQU-001 (Ivermectin) Suppresses Spasms in a Rat Model of Infantile Epileptic Spasms Syndrome
No full textWe investigated effects of long-term and acute administration of EQU-001 (ivermectin) against NMDA-triggered spasms in immature rats prenatally exposed to betamethasone and in the model of infantile epilepsy spasms syndrome (IESS). Pregnant rats were injected with betamethasone on gestational day 15 (2 ×0.4 mg/kg, i.p.). Offspring were injected with ivermectin once daily (1-4 mg/kg, i.p.) from postnatal day (P) 10 through P15. Spasms were triggered on P15 with NMDA (17 mg/kg, i.p.). Other rats received a single dose of ivermectin (1-8 mg/kg, i.p.) on P15 prior to NMDA to test acute anticonvulsant activity. Also, a randomized model was used: The spasms were triggered on P12 and ivermectin treatment (4 mg/kg) was initiated after this bout of spasms on P12, P13 and P14, with additional spasms elicited on P13 and P15. A nicotinic cholinergic α7 agonist was used to mimic effects of ivermectin, and α7 antagonist was used together with ivermectin to prevent its effects. P10-P15 administration of 4 mg/kg of ivermectin significantly suppressed occurrence of spasms on P15, an effect comparable to that of ACTH (positive control). Conversely, an acute P15 administration of ivermectin had no effects on spasms. Ivermectin in the randomized trial suppressed occurrence of spasms as well P15/P12 ratio of spasms. Ivermectin also decreased body weight gain in those animals. None of the nicotinic cholinergic α7 drugs mimicked or prevented effects of ivermectin. Our data indicate that ivermectin may become a powerful tool in the armamentarium for treatment of IESS, however the mechanisms of this action remain to be determined
InTouch Week of February 23, 2026
No full textKeep Your Heart Healthy This February TCDM and NYMC Students Volunteer at Guidance Center of Westchester Off Campus, On Craft: Ralph Torres Keeps Campus Operations Flying Highhttps://touroscholar.touro.edu/in_touch/1392/thumbnail.jp
Early Initiation of Enzyme Replacement Therapy as Facilitated by Newborn Screening Improves Health Outcomes Among Patients With Infantile-Onset Pompe Disease
No full textPURPOSE: To assess the benefits of early enzyme replacement therapy (ERT) in patients with infantile-onset Pompe disease (IOPD). METHODS: A retrospective chart review of 17 IOPD (7 cross-reactive immunologic material [CRIM]-negative and 10 CRIM positive) who initiated ERT (alglucosidase alfa) ≤4 weeks of age and had ≥18 months follow-up was performed. RESULTS: Patients received starting doses of 20 mg/kg/every other week (n = 11), 20 mg/kg/week (n = 3), or 40 mg/kg/week (n = 3). Six CRIM-negative and 2 patients who were CRIM positive received immune tolerance induction (ITI) with Rituximab+Methotrexate+intravenous immunoglobulin. Five patients who were CRIM positive received transient low-dose methotrexate. All CRIM-negative patients were immune tolerant. Three patients who were CRIM positive developed high-sustained antibody titers (HSAT); 2 were immune tolerant after bortezomib-based ITI. One patient who was CRIM positive developed HSAT, was invasively ventilated, and succumbed at age 5.2 years. At the most recent follow-up (MRFU; 3.1-18.4 years), 16 patients were alive, ambulatory, feeding orally, invasive ventilator-free, and receiving high-dose ERT (median lifelong dose 2.76X; 1.36-4.00). All patients experienced left ventricular mass index and Glc reductions and for a subset, biomarkers were within normal limits at MRFU (left ventricular mass index:16/17, AST:9/17, CK:5/17, and Glc:5/16). CONCLUSION: These data highlight the benefits of early ERT initiation and ITI, along with high-dose ERT. Despite early treatment, patients with IOPD remain at risk of developing HSAT
Surveying Current Practices in the Use of Gadolinium-Based Contrast Agents for Routine Brain Magnetic Resonance Imaging in the Evaluation of Isolated Growth Hormone Deficiency Among US Pediatric Endocrinologists
No full textINTRODUCTION: This survey investigates brain MRI practices for isolated GHD among Pediatric Endocrine Society (PES) members, focusing on gadolinium-based contrast agents (GBCAs) versus non-contrast MRI. METHODS: A 15-question survey was distributed to 1,553 PES members, capturing data on GBCA usage, non-contrast imaging access, and awareness of gadolinium retention. RESULTS: A total of 85% of respondents routinely order brain MRIs for isolated GHD, with 60% using GBCAs. Most respondents have access to high-resolution non-contrast imaging, though 54% are unaware of gadolinium retention risks. CONCLUSION: High-resolution non-contrast MRI demonstrates diagnostic efficacy, suggesting a shift away from GBCAs in clinic practice for isolated GHD. The survey forms the basis to update PES guidelines in the evaluation of isolated GHD
Low-Carbohydrate/Ketogenic Diet and Coronary Artery Disease: A Brief Review of the Limited Evidence Between Them
No full textNowadays there is a lot of interest among the general population regarding the ketogenic diet (KD) and its health benefits. Most people following this diet have a reduced intake of carbohydrates which gets replaced by calories coming from fat and protein. Even though KD has shown some limited health benefits, there is no consensus on long-term effects and cardiovascular safety profile, especially the relation of KD to coronary artery disease (CAD). This concern comes predominantly from increased fat intake in KD and other similar diets with decreased carbohydrate intake. One study has shown a link between type 1 diabetes and increased coronary artery calcium scores but, in addition to many other limitations, after adjusting for other cardiovascular risk factors, the association was not significant. Results from a subanalysis of the CARDIA prospective study found that progression of CAD measured by coronary artery calcium was more pronounced in people with low-carbohydrate intake, especially when the compensatory calorie intake was from animal sources as compared to plant-based sources. In addition, other studies have tried to find a link between this type of diet and other traditional cardiovascular risk factors that have been traditionally associated with CAD, especially comparing low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (TAG) levels without clear clinical significance. Other studies found an association between KD and all-cause mortality, but no association with cardiovascular mortality. Lastly, there is an association between animal-based KD and all-cause mortality in patients who have already suffered a myocardial infarction. These findings are modified when accounting for saturated fat intake, which may give us an insight into possible mechanisms to explain these differences
InTouch Week of March 2, 2026
No full textKartik Prabhakaran, M.D., to Lead Department of Surgery Uncovering an Early Driver of Pulmonary Arterial Hypertension What if Banana Bags Came Ready to Use? NYMC and TU Host Ninety Minutes: The Medical Magazine of the Web Pet the Stress Away Brings Comfort to NYMC Free Shipping on NYMC Gear Student Spotlight: Building an Orthopedic Futurehttps://touroscholar.touro.edu/in_touch/1393/thumbnail.jp
The Shochet: A Memoir of Jewish Life in Ukraine and Crimea (Vol. 2)
No full textSet in Ukraine, Crimea, and Israel, this unique two-volume autobiography offers a fascinating, detailed picture of life in Tsarist Russia and Israel during the late 19th and early 20th centuries. Goldenshteyn (1848-1930), a traditional Jew who was orphaned as a young boy and became a shochet (kosher slaughterer) as a young man, is a master storyteller. Folksy, funny, streetwise, and self-confident, he is a keen observer of his surroundings. His accounts are vivid and readable, sometimes stunning in their intensity.
The memoir is brimming with information. Goldenshteyn’s adventures shed light on communal life, persecution, family relationships, religious practices and beliefs, social classes, local politics, interactions between Jews and other religious communities, epidemics, poverty, competition for resources, migration, war, technology, modernity and secularization. In chronicling his own life, Goldenshteyn inadvertently tells a bigger story—the story of how a small, oppressed people, among other minority groups, struggled for survival in the massive Russian Empire and in the Land of Israel.
Volume two begins in 1873, when Goldenshteyn obtains his first position as a shochet in Slobodze, and it follows him to the Crimea, where he endures 34 years of vicissitudes. In 1913, he fulfills a dream of immigrating to the Land of Israel, hoping to find tranquility in his old age. Instead, he is met with the turbulence of the First World War, as battles rage between the retreating Ottoman Turks and the advancing British forces.
Informed by research in Ukrainian, Israeli and American archives and personal interviews with the few surviving individuals who knew Goldenshteyn personally, The Shochet is a magnificent new contribution to Jewish and Eastern European history.https://touroscholar.touro.edu/tup/1048/thumbnail.jp